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Richardson M. What are the possible barriers and benefits to the use of dental therapists within the UK Military Dental Service? Br Dent J 2022; 232:232-238. [PMID: 35217744 DOI: 10.1038/s41415-022-3985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
Introduction All dental service delivery organisations and their workforce need to adopt more efficient and effective delivery models including increased skill-mix.Aim The aim of this study was to investigate the possible barriers/benefits to the utilisation of dental therapists (DTs) in the UK Military Dental Service.Method An explanatory mixed-methods study of sequential design was conducted using purposive sampling of dentists and DTs in the Defence Military Service. Electronic questionnaires (25) were sent to dentists and DTs with an overall response rate of 80% (15/18 dentists and 6/7 DTs). Following analysis of the questionnaires, seven semi-structured interviews (four dentists, three DTs) were thematically analysed.Results All dentists and DTs agreed that DTs could play a positive role within the Defence Military Service, but the barriers and benefits of their use centred on the six main themes of: leadership, delegation, new ways of working, scope of practice, skill-mix and utilisation.Conclusions To address the barriers and maximise the benefits of using DTs, effective leadership at the organisational, dental centre and individual levels is required. This leadership is key to unlocking the benefits of improved teamwork, increased skill-mix and maximised use of all dental care professionals within the Defence Military Service.
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Affiliation(s)
- Mark Richardson
- Chief Dental Officer (Defence), Defence Primary Healthcare (Dental), DMS Whittington, Lichfield, Staffordshire, WS14 9PY, UK.
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Crisan EL, Covaliu BF, Chis DM. A Systematic Literature Review of Quality Management Initiatives in Dental Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11084. [PMID: 34769604 PMCID: PMC8582852 DOI: 10.3390/ijerph182111084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.
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Affiliation(s)
- Emil Lucian Crisan
- Faculty of Economics and Business Administration, Department of Management, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
| | - Bogdan Florin Covaliu
- Faculty of Medicine, Department of Community Medicine, Public Health and Management, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400337 Cluj-Napoca, Romania
| | - Diana Maria Chis
- Faculty of Economics and Business Administration, Department of Finance, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
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Brocklehurst P, Hoare Z, Woods C, Williams L, Brand A, Shen J, Breckons M, Ashley J, Jenkins A, Gough L, Preshaw P, Burton C, Shepherd K, Bhattarai N. Dental therapists compared with general dental practitioners for undertaking check-ups in low-risk patients: pilot RCT with realist evaluation. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background
Many dental ‘check-ups’ in the NHS result in no further treatment. The patient is examined by a dentist and returned to the recall list for a further check-up, commonly in 6 or 12 months’ time. As the oral health of regular dental attenders continues to improve, it is likely that an increasing number of these patients will be low risk and will require only a simple check-up in the future, with no further treatment. This care could be delivered by dental therapists. In 2013, the body responsible for regulating the dental profession, the General Dental Council, ruled that dental therapists could see patients directly and undertake check-ups and routine dental treatments (e.g. fillings). Using dental therapists to undertake check-ups on low-risk patients could help free resources to meet the future challenges for NHS dentistry.
Objectives
The objectives were to determine the most appropriate design for a definitive study, the most appropriate primary outcome measure and recruitment and retention rates, and the non-inferiority margin. We also undertook a realist-informed process evaluation and rehearsed the health economic data collection tool and analysis.
Design
A pilot randomised controlled trial over a 15-month period, with a realist-informed process evaluation. In parallel, we rehearsed the health economic evaluation and explored patients’ preferences to inform a preference elicitation exercise for a definitive study.
Setting
The setting was NHS dental practices in North West England.
Participants
A total of 217 low-risk patients in eight high-street dental practices participated.
Interventions
The current practice of using dentists to provide NHS dental check-ups (treatment as usual; the control arm) was compared with using dental therapists to provide NHS dental check-ups (the intervention arm).
Main outcome measure
The main outcome measure was difference in the proportion of sites with bleeding on probing among low-risk patients. We also recorded the number of ‘cross-over’ referrals between dentists and dental therapists.
Results
No differences were found in the health status of patients over the 15 months of the pilot trial, suggesting that non-inferiority is the most appropriate design. However, bleeding on probing suffered from ‘floor effects’ among low-risk patients, and recruitment rates were moderately low (39.7%), which suggests that an experimental design might not be the most appropriate. The theory areas that emerged from the realist-informed process evaluation were contractual, regulatory, institutional logistics, patients’ experience and logistics. The economic evaluation was rehearsed and estimates of cost-effectiveness made; potential attributes and levels that can form the basis of preference elicitation work in a definitive study were determined.
Limitations
The pilot was conducted over a 15-month period only, and bleeding on probing appeared to have floor effects. The number of participating dental practices was a limitation and the recruitment rate was moderate.
Conclusions
Non-inferiority, floor effects and moderate recruitment rates suggest that a randomised controlled trial might not be the best evaluative design for a definitive study in this population. The process evaluation identified multiple barriers to the use of dental therapists in ‘high-street’ practices and added real value.
Future work
Quasi-experimental designs may offer more promise for a definitive study alongside further realist evaluation.
Trial registration
Current Controlled Trials ISRCTN70032696.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, UK
| | - Chris Woods
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Andrew Brand
- School of Health Sciences, Bangor University, Bangor, UK
| | - Jing Shen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alison Jenkins
- School of Health Sciences, Bangor University, Bangor, UK
| | | | - Philip Preshaw
- Faculty of Dentistry, National University of Singapore, Singapore
- Faculty of Dentistry, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Karen Shepherd
- Patient and public involvement representative, Bangor, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Barnes E, Bullock A, Chestnutt IG, Cowpe J, Moons K, Warren W. Dental therapists in general dental practice. A literature review and case-study analysis to determine what works, why, how and in what circumstances. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:109-120. [PMID: 31618492 DOI: 10.1111/eje.12474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive-focussed, teamwork approach. However, success in the adoption of this model of working has been varied. AIMS Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. MATERIALS AND METHODS The research comprised two stages. (a) A structured literature search, dual-coding papers for high-level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill-mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill-mix models incorporating semi-structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. RESULTS Eighty-four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. CONCLUSION Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice.
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Affiliation(s)
- Emma Barnes
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) Cardiff University, Cardiff, UK
| | - Ivor G Chestnutt
- College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Cardiff, UK
| | - Jonathan Cowpe
- College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Cardiff, UK
| | - Kirstie Moons
- The Dental Postgraduate Section, Health Education and Improvement Wales, Cardiff, UK
| | - Wendy Warren
- Aneurin Bevan University Health Board, Cardiff, UK
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Abstract
Aim The aim of this pilot study was to explore the time taken to complete key contemporary dental procedures by dentists and dental hygienists/therapists (DH/DTs) working in primary dental care and their views on the factors that influence the length of time taken to complete individual dental procedures.Materials and methods An exploratory mixed methods study of linear design, involving a questionnaire survey followed by focus group discussions exploring time required to complete dental procedures and influences, was conducted using a purposive sample of dental professionals working in primary dental care within the south east of England. Descriptive analysis of absolute timings was performed, together with thematic analysis of their reported influences.Results Twenty-nine dental professionals completed the questionnaire survey, 11 of whom participated in subsequent focus group discussions to explore the initial findings. While dentists reported higher average times and a wider range for clinical examination and treatment planning, DH/DTs reported spending longer on prevention. Average timings for restorations and extractions were similar across both professional groups. Perceived influences on the length of time required to complete dental procedures were patient complexity, system of care, type of remuneration system and philosophy of care emphasising quality, together with practice environment, including the level of nursing support and surgery-location within the building; individual clinician factors relating to the type of dental professional, their interests and expertise were also identified. Whilst there was general agreement amongst respondents over the range of influencing factors, DH/DTs reported being particularly affected by the current type of remuneration system and level of support within practice.Conclusions Within the limits of a pilot study, this research suggests patterns in timings of the delivery of primary dental care procedures and identifies multiple diverse influences. Further research at national level is required to develop a deeper understanding of the time taken to deliver primary dental care and the impact of various influences to confirm the findings and inform human resource considerations in addressing population oral health needs.
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Barnes E, Bullock A, Cowpe J, Moons K, Warren W, Hannington D, Allen M, Chestnutt IG, Bale S, Negrotti C. General dental practices with and without a dental therapist: a survey of appointment activities and patient satisfaction with their care. Br Dent J 2018; 225:53-58. [DOI: 10.1038/sj.bdj.2018.522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/09/2022]
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Hill H, Macey R, Brocklehurst P. A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom. J Public Health Dent 2017; 77:334-343. [PMID: 28272806 DOI: 10.1111/jphd.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of using mid-level providers for dental "check-up" examinations and the treatment of caries in different NHS settings in the United Kingdom. Mid-level providers are a broad category that describes non-dentist members of dental teams. This study focused on the potential use of Dental Hygiene Therapists undertaking dental "check-up" examinations and simple restorative treatment, instead of dentists. METHODS A Markov model was used to construct the natural history of caries development in adults that visit a dental practice every six months over a five-year period. Three cost perspectives are taken: those borne to dental healthcare providers in England and Wales, Northern Ireland and Scotland. These represent three separate forms of retrospective payment system that are currently in use in the United Kingdom. The cost outcome was the average amount of retained practice earnings required to provide healthcare per patient visit. The health outcome was the average length of time in a cavity-free state and the cost-effectiveness outcome was incremental cost for six months in a cavity-free state. RESULTS No statistical difference was found between dentists and mid-level providers in the length of time in a cavity-free state but the use of the latter saved money in all three NHS health system jurisdictions. This ranged from £7.85 (England and Wales) to £9.16 (Northern Ireland) per patient visit ($10.20 to $11.90, respectively) meaning the incremental cost for six month in a cavity-free state ranged from £261.67 ($339.93) in England and Wales to £305.33 ($369.68) in Northern Ireland. Further, changes in baseline assumptions and parameter values did not change mid-level providers being the dominant service intervention. CONCLUSION In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.
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Affiliation(s)
- Harry Hill
- School of Dentistry, The University of Manchester, Manchester, UK.,Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Richard Macey
- Centre for Endrocinology and Diabetes, The University of Manchester, Manchester, UK
| | - Paul Brocklehurst
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
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Brocklehurst P, Birch S, McDonald R, Hill H, O’Malley L, Macey R, Tickle M. Determining the optimal model for role substitution in NHS dental services in the UK: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundMaximising health gain for a given level and mix of resources is an ethical imperative for health-service planners. Approximately half of all patients who attend a regular NHS dental check-up do not require any further treatment, whereas many in the population do not regularly attend. Thus, the most expensive resource (the dentist) is seeing healthy patients at a time when many of those with disease do not access care. Role substitution in NHS dentistry, where other members of the dental team undertake the clinical tasks previously provided by dentists, has the potential to increase efficiency and the capacity to care and lower costs. However, no studies have empirically investigated the efficiency of NHS dental provision that makes use of role substitution.Research questionsThis programme of research sought to address three research questions: (1) what is the efficiency of NHS dental teams that make use of role substitution?; (2) what are the barriers to, and facilitators of, role substitution in NHS dental practices?; and (3) how do incentives in the remuneration systems influence the organisation of these inputs and production of outputs in the NHS?DesignData envelopment analysis was used to develop a productive efficiency frontier for participating NHS practices, which were then compared on a relative basis, after controlling for patient and practice characteristics. External validity was tested using stochastic frontier modelling, while semistructured interviews explored the views of participating dental teams and their patients to role substitution.SettingNHS ‘high-street’ general dental practices.Participants121 practices across the north of England.InterventionsNo active interventions were undertaken.Main outcome measuresRelative efficiency of participating NHS practices, alongside a detailed narrative of their views about role substitution dentistry. Social acceptability for patients.ResultsThe utilisation of non-dentist roles in NHS practices was relatively low, the most common role type being the dental hygienist. Increasing the number of non-dentist team members reduced efficiency. However, it was not possible to determine the relative efficiency of individual team members, as the NHS contracts only with dentists. Financial incentives in the NHS dental contract and the views of practice principals (i.e. senior staff members) were equally important. Bespoke payment and referral systems were required to make role substitution economically viable. Many non-dentist team members were not being used to their full scope of practice and constraints on their ability to prescribe reduced efficiency further. Many non-dentist team members experienced a precarious existence, commonly being employed at multiple practices. Patients had a low level of awareness of the different non-dentist roles in a dental team. Many exhibited an inherent trust in the professional ‘system’, but prior experience of role substitution was important for social acceptability.ConclusionsBetter alignment between the financial incentives within the NHS dental contract and the use of role substitution is required, although professional acceptability remains critical.Study limitationsOutput data collected did not reflect the quality of care provided by the dental team and the input data were self-reported.Future workFurther work is required to improve the evidence base for the use of role substitution in NHS dentistry, exploring the effects and costs of provision.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Stephen Birch
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ruth McDonald
- Manchester Business School, University of Manchester, Manchester, UK
| | - Harry Hill
- School of Dentistry, University of Manchester, Manchester, UK
| | - Lucy O’Malley
- School of Dentistry, University of Manchester, Manchester, UK
| | - Richard Macey
- School of Dentistry, University of Manchester, Manchester, UK
| | - Martin Tickle
- School of Dentistry, University of Manchester, Manchester, UK
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Hulme C, Robinson P, Douglas G, Baxter P, Gibson B, Godson J, Vinall-Collier K, Saloniki E, Meads D, Brunton P, Pavitt S. The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BackgroundOver the past decade, commissioning of primary care dentistry has seen contract currency evolving from payment for units of dental activity (UDAs) towards blended contracts that include key performance indicators such as access, quality and improved health outcome.ObjectivesThe aim of this study was to evaluate a blended/incentive-driven model of dental service provision. To (1) explore stakeholder perspectives of the new service delivery model; (2) assess the effectiveness of the new service delivery model in reducing the risk of and amount of dental disease and enhancing oral health-related quality of life (OHQoL) in patients; and (3) assess cost-effectiveness of the new service delivery model.MethodsUsing a mixed-methods approach, the study included three dental practices working under the blended/incentive-driven (incentive) contract and three working under the UDAs (traditional) contract. All were based in West Yorkshire. The qualitative study reports on the meaning of key aspects of the model for three stakeholder groups [lay people (patients and individuals without a dentist), commissioners and the primary care dental teams], with framework analysis of focus group and semistructured interview data. A non-randomised study compared clinical effectiveness and cost-effectiveness of treatment under the two contracts. The primary outcome was gingivitis, measured using bleeding on probing. Secondary outcomes included OHQoL and cost-effectiveness.ResultsParticipants in the qualitative study associated the incentive contract with more access, greater use of skill mix and improved health outcomes. In the quantitative analyses, of 550 participants recruited, 291 attended baseline and follow-up. Given missing data and following quality assurance, 188 were included in the bleeding on probing analysis, 187 in the caries assessment and 210 in the economic analysis. The results were mixed. The primary outcome favoured the incentive practices, whereas the assessment of caries favoured the traditional practices. Incentive practices attracted a higher cost for the service commissioner, but were financially attractive for the dental provider at the practice level. Differences in generic health-related quality of life were negligible. Positive changes over time in OHQoL in both groups were statistically significant.LimitationsThe results of the quantitative analysis should be treated with caution given small sample numbers, reservations about the validity of pooling, differential dropout results and data quality issues.ConclusionsA large proportion of people in this study who had access to a dentist did not follow up on oral care. These individuals are more likely to be younger males and have poorer oral health. Although access to dental services was increased, this did not appear to facilitate continued use of services.Future workFurther research is required to understand how best to promote and encourage appropriate dental service attendance, especially among those with a high level of need, to avoid increasing health inequalities, and to assess the financial impact of the contract. For dental practitioners, there are challenges around perceptions about preventative dentistry and use of the risk assessments and care pathways. Changes in skill mix pose further challenges.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Peter Robinson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Gail Douglas
- School of Dentistry, University of Leeds, Leeds, UK
| | - Paul Baxter
- Division of Biostatistics, University of Leeds, Leeds, UK
| | - Barry Gibson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jenny Godson
- Division of Population Health and Care, Health and Wellbeing Directorate, Public Health England, London, UK
| | | | - Eirini Saloniki
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Brunton
- School of Dentistry, University of Leeds, Leeds, UK
| | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
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Wanyonyi KL, Radford DR, Harper PR, Gallagher JE. Alternative scenarios: harnessing mid-level providers and evidence-based practice in primary dental care in England through operational research. HUMAN RESOURCES FOR HEALTH 2015; 13:78. [PMID: 26369553 PMCID: PMC4570749 DOI: 10.1186/s12960-015-0072-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/26/2015] [Indexed: 05/30/2023]
Abstract
BACKGROUND In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs. AIM The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers. METHODS An operational research model and four alternative scenarios to test the potential for skill mix use in primary care in England were developed, informed by the model of care at a primary dental care training centre in the south of England, professional policy including scope of practice and contemporary evidence-based preventative practice. The model was developed in Excel and drew on published national timings and salary costs. The scenarios included the following: "No Skill Mix", "Minimal Direct Access", "More Prevention" and "Maximum Delegation". The scenario outputs comprised clinical time, workforce numbers and salary costs required for state-funded primary dental care in England. RESULTS The operational research model suggested that 73% of clinical time in England's state-funded primary dental care in 2011/12 was spent on tasks that may be delegated to dental care professionals (DCPs), and 45- to 54-year-old patients received the most clinical time overall. Using estimated National Health Service (NHS) clinical working patterns, the model suggested alternative NHS workforce numbers and salary costs to meet the dental demand based on each developed scenario. For scenario 1:"No Skill Mix", the dentist-only scenario, 81% of the dentists currently registered in England would be required to participate. In scenario 2: "Minimal Direct Access", where 70% of examinations were delegated and the primary care training centre delegation patterns for other treatments were practised, 40% of registered dentists and eight times the number of dental therapists currently registered would be required; this would save 38% of current salary costs cf. "No Skill Mix". Scenario 3: "More Prevention", that is, the current model with no direct access and increasing fluoride varnish from 13.1% to 50% and maintaining the same model of delegation as scenario 2 for other care, would require 57% of registered dentists and 4.7 times the number of dental therapists. It would achieve a 1% salary cost saving cf. "No Skill Mix". Scenario 4 "Maximum Delegation" where all care within dental therapists' jurisdiction is delegated at 100%, together with 50% of restorations and radiographs, suggested that only 30% of registered dentists would be required and 10 times the number of dental therapists registered; this scenario would achieve a 52% salary cost saving cf. "No Skill Mix". CONCLUSION Alternative scenarios based on wider expressed treatment need in national primary dental care in England, changing regulations on the scope of practice and increased evidence-based preventive practice suggest that the majority of care in primary dental practice may be delegated to dental therapists, and there is potential time and salary cost saving if the majority of diagnostic tasks and prevention are delegated. However, this would require an increase in trained DCPs, including role enhancement, as part of rebalancing the dental workforce.
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Affiliation(s)
- Kristina L Wanyonyi
- King's College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, UK.
| | - David R Radford
- King's College London Dental Institute, Teaching Division, Guys Tower, Guys Hospital, London, UK.
- University of Portsmouth Dental Academy, Hampshire Terrace, Portsmouth, UK.
| | - Paul R Harper
- Cardiff University, School of Mathematics, Cardiff, UK.
| | - Jennifer E Gallagher
- King's College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, UK.
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Hopcraft M, Martin-Kerry JM, Calache H. Dental therapists’ expanded scope of practice in Australia: a 12-month follow-up of an educational bridging program to facilitate the provision of oral health care to patients 26+ years. J Public Health Dent 2015; 75:234-44. [DOI: 10.1111/jphd.12094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/06/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew Hopcraft
- Assessments & Examinations; Australian Dental Council Ltd; Melbourne Victoria Australia
| | | | - Hanny Calache
- Oral Health Leadership; Dental Health Services Victoria; Carlton Victoria Australia
- Department of Dentistry and Oral Health; La Trobe University; Melbourne Victoria Australia
- Melbourne Dental School; The University of Melbourne; Parkville Victoria Australia
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12
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Commentaries on health services research. JAAPA 2013. [DOI: 10.1097/01.jaa.0000433964.22547.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Blue CM, Funkhouser DE, Riggs S, Rindal DB, Worley D, Pihlstrom DJ, Benjamin P, Gilbert GH. Utilization of nondentist providers and attitudes toward new provider models: findings from the National Dental Practice-Based Research Network. J Public Health Dent 2013; 73:237-44. [PMID: 23668892 DOI: 10.1111/jphd.12020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 04/07/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to quantify, within the National Dental Practice-Based Research Network, current utilization of dental hygienists and assistants with expanded functions and quantify network dentists' attitudes toward a new nondentist provider model - the dental therapist. METHODS National Dental Practice-Based Research Network practitioner-investigators participated in a single, cross-sectional administration of a questionnaire. RESULTS Current nondentist providers are not being utilized by network practitioner-investigators to the fullest extent allowed by law. Minnesota practitioners, practitioners in large group practices, and those with prior experience with expanded-function nondentist providers delegate at a higher rate and had more-positive perceptions of the new dental therapist model. CONCLUSIONS Expanding scopes of practice for dental hygienists and assistants has not translated to the maximal delegation allowed by law among network practices. This finding may provide insight into dentists' acceptance of newer nondentist provider models.
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Affiliation(s)
- Christine M Blue
- Department of Primary Dental Care, University of Minnesota, Minneapolis, MN, USA
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Gallagher JE, Lim Z, Harper PR. Workforce skill mix: modelling the potential for dental therapists in state-funded primary dental care. Int Dent J 2013; 63:57-64. [DOI: 10.1111/idj.12006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Robinson PG, Dyer TA, Teusner D. The influence of population oral health on the dental team. Community Dent Oral Epidemiol 2012; 40 Suppl 2:16-21. [PMID: 22998299 DOI: 10.1111/j.1600-0528.2012.00714.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This presentation focuses on the use of dental therapists as substitutes for dentists in the provision of some aspects of dental care. Our premise is that the use of therapists is a 'good thing' if it delivers a higher quality service. The care that may be provided by therapists is appropriate to population needs. They have been used to increase access to care in a number of countries by supplementing the volume and reach of services, which enhances equity. Therapists are socially acceptable where they are integrated into existing dental systems, but concerted work may be necessary to increase their acceptability if their use is to be introduced or expanded elsewhere. There is no reason to suspect that therapists offer less effective care than dentists, and available data are compatible with this view. More data may be required to lend political support for their greater use. The efficiency of teams is sensitive to the way in which they are organized and funded. Substitution of dentists by therapists within small dental teams creates complexities and costs that reduce efficiency. Conversely, where therapists can work with relative independence, diagnosing and treating patients without direct supervision, then efficiency may be high. Despite opportunities for improving the quality of care, the main barrier for increasing their use is the dental profession. Dental organizations tend to act as guilds, preventing or restricting the deployment of therapists. Dental public health practitioners therefore have a role as advocates for their greater use. At present, the use of therapists does not appear to be influenced by the health of the population.
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Affiliation(s)
- Peter G Robinson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
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Bailit HL, Beazoglou TJ, DeVitto J, McGowan T, Myne-Joslin V. Impact of Dental Therapists on Productivity and Finances: I. Literature Review. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.8.tb05359.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Howard L. Bailit
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
| | - Tryfon J. Beazoglou
- Department of Craniofacial Sciences; School of Dental Medicine; University of Connecticut Health Center
| | - Judy DeVitto
- University of Connecticut Health Center Finance Corporation
| | - Taegen McGowan
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
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Beazoglou TJ, Lazar VF, Guay AH, Heffley DR, Bailit HL. Dental Therapists in General Dental Practices: An Economic Evaluation. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.8.tb05362.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tryfon J. Beazoglou
- Department of Craniofacial Sciences; School of Dental Medicine; University of Connecticut Health Center
| | | | | | | | - Howard L. Bailit
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
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Beazoglou TJ, Bailit HL, DeVitto J, McGowan T, Myne-Joslin V. Impact of Dental Therapists on Productivity and Finances: II. Federally Qualified Health Centers. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.8.tb05360.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tryfon J. Beazoglou
- Department of Craniofacial Sciences; School of Dental Medicine; University of Connecticut Health Center
| | - Howard L. Bailit
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
| | - Judy DeVitto
- University of Connecticut Health Center Finance Corporation
| | - Taegen McGowan
- Department of Community Medicine; School of Medicine; University of Connecticut Health Center
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Lopez N, Blue CM, Self KD. Dental School Faculty Perceptions of and Attitudes Toward the New Dental Therapy Model. J Dent Educ 2012. [DOI: 10.1002/j.0022-0337.2012.76.4.tb05270.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Naty Lopez
- School of Dentistry University of Minnesota
| | | | - Karl D. Self
- Division of Dental Therapy; School of Dentistry University of Minnesota
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Harris RV, Sun N. Translation of remuneration arrangements into incentives to delegate to English dental therapists. Health Policy 2011; 104:253-9. [PMID: 22177418 DOI: 10.1016/j.healthpol.2011.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 11/10/2011] [Accepted: 11/27/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate how changes to the dental remuneration system have translated into disincentives to delegate to dental therapists in dental practices. METHOD A purposive sample of nine practices was identified incorporating a mix of small, medium and large practices, both with and without dental therapists (DTs). Semi-structured interviews were carried out with 48 principal dentists, associate dentists, DTs, practice managers and dental hygienists. Interview transcripts were analysed using a general inductive approach to identify themes and sub-themes. RESULTS Four themes were identified: practice finances, productivity, lack of management information relating to the use of DTs, and fairness. DTs were often seen as a 'cost' to the team, rather than part of the team as a whole, within a system where contributions were evaluated according to a cost-volume-profit business model. Thus DTs were expected to be 'self-financing'. The fairness of deducting the salary costs of the DT from associate dentists' income was an issue. CONCLUSIONS The study reveals that the financial risk sharing model which predominates in dental practice significantly influences how the remuneration system translates into establishing delegation incentives. New organisational forms or a shift in practitioner worldviews of team-working are needed in order for DTs to be fully integrated into dental practice teams.
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Affiliation(s)
- Rebecca V Harris
- Department of Health Services Research, University of Liverpool, United Kingdom
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Brocklehurst P, Tickle M. The policy context for skill mix in the National Health Service in the United Kingdom. Br Dent J 2011; 211:265-9. [DOI: 10.1038/sj.bdj.2011.765] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 11/09/2022]
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Is skill mix profitable in the current NHS dental contract in England? Br Dent J 2011; 210:303-8. [PMID: 21475274 DOI: 10.1038/sj.bdj.2011.238] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2010] [Indexed: 11/08/2022]
Abstract
The use of skill mix in medicine is now widespread, yet it appears that its use in dentistry is not as prominent. Unlike doctors, dentists are required to mitigate the financial risk produced by their capital investment and ensure an adequate cash flow to cover their annual running costs. Examining the financial incentives for employing dental care professionals is therefore an important step to understand why dentistry appears to lag behind medicine in skill mix. It is also apposite, given the announcement of the coalition government to develop a new contract, which could introduce incentives for the use of dental care professionals in this way. The purpose of this short paper is to examine whether skill mix is profitable for general dental practices under the existing NHS contract in England.
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Models of practice organisation using dental therapists: English case studies. Br Dent J 2011; 211:E6. [DOI: 10.1038/sj.bdj.2011.624] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2011] [Indexed: 11/08/2022]
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Affiliation(s)
- Naty Lopez
- School of Dentistry; University of Minnesota
| | - Christine M. Blue
- Division of Dental Hygiene; School of Dentistry; University of Minnesota
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Turner S, Ross MK, Ibbetson RJ. Job satisfaction among dually qualified dental hygienist-therapists in UK primary care: a structural model. Br Dent J 2011; 210:E5. [DOI: 10.1038/sj.bdj.2011.50] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2010] [Indexed: 11/09/2022]
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An evaluation of a vocational training scheme for dental therapists (TVT). Br Dent J 2010; 209:295-300. [PMID: 20871556 DOI: 10.1038/sj.bdj.2010.818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2010] [Indexed: 11/09/2022]
Abstract
Commissioned by NHS Education South Central (NESC) Postgraduate Dental Deanery, this work provided an external, independent formative evaluation of the Dental Therapists Vocational Training (TVT) scheme in its first year of operation. Undertaken between March-September 2009, the evaluation engaged with all those involved in the TVT scheme: the newly qualified dental therapists (n = 9; group discussion and questionnaire; portfolio extracts) and interviews with their trainers (n = 9), Associate Postgraduate Dental Dean and TVT Scheme Adviser. Most of those on the scheme did not feel well prepared for work at the point of initial qualification and benefitted from enhancement of confidence and skills. Although the number of treatments undertaken by each of the trainees varied considerably, there was commonality in terms of treatment types. Benefits for trainers included the opportunity to work with a dental therapist and develop a better understanding of their role. They praised the trainees' skills with nervous patients and children and their preventative work. A therapist on the team released the dentist for more complex treatments. Challenges related to the recruitment of trainees and trainers, the relative lack of knowledge about the work of dental therapists, concerns about maintaining the range of therapy skills and issues about UDA (unit of dental activity) distribution. There was widespread support for a mandatory TVT scheme. This scheme could be improved by providing further guidance on the amount and type of clinical experience required.
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Patient satisfaction with care by dental therapists. Br Dent J 2010; 208:E9; discussion 212-3. [PMID: 20228732 DOI: 10.1038/sj.bdj.2010.209] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2009] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Patient reported outcomes of care are increasingly used as a measure of the quality of care. There has been a recent expansion in the number of dental therapists trained in the UK, and with legislation now permitting therapists to take on a wider role in dental practice, patients' perceptions about quality of care provided by therapists is an important issue.Objectives To investigate whether there were any differences in patient satisfaction after a visit to a therapist, compared to a visit to a dentist. METHOD A ten-item scale of patient satisfaction (Dental Visit Satisfaction Scale), which provides an outcome measure of overall patient satisfaction as well as three sub-scale outcomes (information-communication; understanding-acceptance; and technical competence) was used. A total of 240 questionnaires were given to consecutive patients attending an appointment with a therapist and 400 questionnaires were given to patients attending dentists, in eight different dental practices. RESULTS Four hundred and thirty-one (67.3%) questionnaires were returned. Patients attending therapists were found to have a significantly higher level of overall satisfaction (p <0.001) and also in all three sub-scales (p <0.001), than those attending appointments with dentists. CONCLUSION Although a clear distinction in patient satisfaction according to the type of provider was found, the reasons behind this finding are unclear, and so care needs to be taken in interpreting the results, with further work undertaken to explore this phenomenon more fully.
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Williams DM, Medina J, Wright D, Jones K, Gallagher JE. A Review of Effective Methods of Delivery of Care: Skill-Mix and Service Transfer to Primary Care Settings. ACTA ACUST UNITED AC 2010; 17:53-60. [DOI: 10.1308/135576110791013884] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aims Health policy in England is seeking to minimise hospital use and provide access to services in a primary healthcare setting and maximise skill-mix, driven by issues such as cost and access. The aim of this review was to determine the effectiveness of increased use of skill-mix and service transfer within general and oral healthcare. Secondary outcome measures were related to cost, quality, access, health outcomes and satisfaction. Methods Data sources were the Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination DARE, British Nursing Index, CINAHL, EMBASE, MEDLINE, and PsycINFO from 1996 to August 2008. The reference lists of relevant papers were scanned to identify additional studies. Data selection A rapid appraisal of systematic reviews, randomised controlled trials, controlled trials and service evaluations in relation to specialist services, practitioners with a special interest, medical and dental, nursing and dental care professionals, together with evidence of service shifts from secondary to primary care was undertaken. Results A total of 206 papers were reviewed. All titles and abstracts of articles and papers found were extracted and validated according to predefined criteria. They were screened for relevance by two researchers, who assessed trial quality and extracted data. Twenty-six papers met the inclusion criteria. The literature demonstrated limited evidence of the cost-effectiveness and health outcomes associated with changes in setting and skill-mix. However, there was evidence of improved access, patient and professional satisfaction. Conclusions There is an overwhelming need for well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce.
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Affiliation(s)
- David M Williams
- Research Associate in Oral Health Services Research and Dental Public Health (formerly)
- King's College London Dental Institute, London, UK
| | | | - Desmond Wright
- Dental Public Health, NHS Tower Hamlets, London, UK; Honorary Lecturer
- King's College London Dental Institute, London, UK
| | - Kate Jones
- Dental Public Health, NHS Sheffield, UK; Honorary Lecturer
- King's College London Dental Institute, London, UK
| | - Jennifer E Gallagher
- Honorary Consultant to NHS Lambeth, London, UK
- King's College London Dental Institute, London, UK
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Dental therapy in the United Kingdom: part 4. Teamwork – is it working for dental therapists? Br Dent J 2009; 207:529-36. [DOI: 10.1038/sj.bdj.2009.1104] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2009] [Indexed: 11/08/2022]
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Dental therapy in the United Kingdom: part 3. Financial aspects of current working practices. Br Dent J 2009; 207:477-83. [DOI: 10.1038/sj.bdj.2009.1010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2009] [Indexed: 11/08/2022]
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Godson JH, Williams SA, Csikar JI, Bradley S, Rowbotham JS. Dental therapy in the United Kingdom: part 2. A survey of reported working practices. Br Dent J 2009; 207:417-23. [DOI: 10.1038/sj.bdj.2009.962] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2009] [Indexed: 11/09/2022]
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Dental therapy in the United Kingdom: part 1. Developments in therapists' training and role. Br Dent J 2009; 207:355-9. [DOI: 10.1038/sj.bdj.2009.900] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2009] [Indexed: 11/08/2022]
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Influences on dentists' decisions to refer paediatric patients to dental hygienists and therapists for fissure sealants: a qualitative approach. Br Dent J 2009; 207:E13; discussion 326-7. [DOI: 10.1038/sj.bdj.2009.856] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2009] [Indexed: 11/08/2022]
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Evans C, Chestnutt IG, Chadwick BL. The potential for delegation of clinical care in general dental practice. Br Dent J 2007; 203:695-9. [DOI: 10.1038/bdj.2007.1111] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jones G, Devalia R, Hunter L. Attitudes of general dental practitioners in Wales towards employing dental hygienist-therapists. Br Dent J 2007; 203:E19; discussion 524-5. [PMID: 17891116 DOI: 10.1038/bdj.2007.890] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2007] [Indexed: 11/08/2022]
Abstract
AIM To examine the attitudes of general dental practitioners in Wales with regard to the employment of dually-qualified hygienist-therapists. DESIGN Questionnaire. RESULTS Responses were received from the principals of 332 of the 550 practices surveyed, a response rate of 60.4%. Fifty-four percent of responding principals currently employed a hygienist and 9% a dually-qualified hygienist-therapist; 43% considered that they were likely to employ hygienist-therapists in the future. Lack of surgery space to accommodate a hygienist-therapist was a problem facing many principals. Disappointingly, respondents demonstrated a clear lack of knowledge in relation to the cost effectiveness of hygienist-therapists, with 39% of principals admitting that this individual would be expected to spend more than half their working time on hygiene treatment. Sixty percent of principals placed an associate among their first three preferences to fill spare capacity, while only 28% selected a hygienist-therapist. CONCLUSION This study has provided local evidence to inform workforce planning and identified a need to ensure that all members of the dental team understand the roles and responsibilities of colleagues.
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Affiliation(s)
- G Jones
- Training and Education Centre for Dental Care Professionals, Division of Adult Dental Health, Cardiff University School of Dentistry, Heath Park, Cardiff
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Hornby P, Stokes E, Russell W, Cochrane D, Morris J. A dental workforce review for a Midlands Strategic Health Authority. Br Dent J 2006; 200:575-9; discussion 567; quiz 588. [PMID: 16732251 DOI: 10.1038/sj.bdj.4813588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2005] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore opportunities for workforce development in NHS general dental services (GDS) in Shropshire and Staffordshire. METHOD Secondary data sources were supplemented with a primary survey of GDS practices to build up a profile of the existing GDS workforce and its current capacity. Attitudes and perceptions on current workforce issues and potential solutions were gathered using a second survey and explored further through other qualitative techniques including interviews and a focus group discussion. RESULTS The results confirm that there is a shortage of dentists in the area, fuelled by multiple factors including the move from NHS to private work, the decision to retire early and a growing disillusionment with NHS policies and remuneration. Modelling of alternate approaches to future dental clinical needs highlighted the opportunity for meeting the consequent workforce demands through increased involvement of hygienists and therapists. CONCLUSIONS This study has provided local evidence to inform dental service development in Shropshire and Staffordshire. It has provided a starting point for exploring new ways of working and will contribute towards a more effective implementation of new and evolving service strategies.
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Affiliation(s)
- P Hornby
- Centre for Health Planning and Management, Keele University, Staffordshire, ST5 5BG.
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Abstract
This paper aims to draw attention to the common oral and dental diseases and conditions in childhood in the context of aetiological factors and to highlight how many of the risk factors for oral and dental ill health are common to other areas of chronic diseases among this age group: diet, hygiene, trauma, stress, and in older children and adolescents, smoking, alcohol use, and use of illegal substances. Suggestions as to how to address these common risk factors are proposed.
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Affiliation(s)
- J H Nunn
- Public and Child Dental Health, School of Dental Science, Lincoln Place, Dublin 2, Ireland.
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Ward P. The changing skill mix – experiences on the introduction of the dental therapist into general dental practice. Br Dent J 2006; 200:193-7. [PMID: 16501524 DOI: 10.1038/sj.bdj.4813251] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2006] [Indexed: 11/08/2022]
Abstract
Health need and demand are outstripping the capacity of the established professions to provide full and responsive services. In these circumstances attention has turned to the role of allied and complementary professionals in all aspect of health provision, not least dentistry. It is in this context that the role of the dental therapist is coming to be of increasing significance to the dental services.
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